POS0609 STRESS-ASSOCIATED INCREASES IN RHEUMATOID ARTHRITIS DISEASE ACTIVITY AND FLARES DURING THE COVID-19 PANDEMIC
Authors: D. Furst, N. T. Morris, A. Q. Pham, T. Woodworth, D. Elashoff, J. Brook, V. Ranganath
Journal: Annals of the Rheumatic Diseases (2022)

Background The novel coronavirus disease 2019 (COVID-19) pandemic has spurred global action. Beginning in March of 2020, the Southern California COVID-19 pandemic response to limit virus transmission was characterized by mandated lockdowns and quarantines, resulting in significant stressors for rheumatology patients and potentially threatening their disease. Objectives To examine factors associated with changes in rheumatoid arthritis (RA) disease activity and flares in the COVID-19 pandemic. Methods RA patients identified by ICD-9/10 codes and active email addresses within a University of California, Los Angeles (UCLA) Rheumatology database were sent surveys via email in July and November of 2020. The survey was UCLA Institutional Review Board approved and included electronic consent and questions related to: perceptions of disease activity/remission via Routine Assessment of Patient Index Data 3 (RAPID3), flare frequency, RA flare questionnaire (RA-FQ), Perceived Stress Scale (PSS-4), and pandemic impact on stress (i.e. emotional state, apprehension, panic, helplessness, work, home, financial, and social distancing stress). Demographics were extracted from electronic medical records. Results were examined via descriptive analyses, Pearson correlations, and chi-square test for comparisons plus linear stepwise regressions where appropriate to evaluate the relationship between stress measures, RA disease activity, and flare frequency and severity. Results Among 5037 patients surveyed, 361 in July and 4676 in November,1128 (22.4%) responded. The study population demographics were: mean age of 57.5 ± 15.1 years, 79.4% female, racially diverse (69.6% Caucasian, 13.7 % LatinX, 9.5 % Asian, and 4.9% Black), and 62% seropositive (CCP and/or RF). Perceived disease activity and remission remained stable in most patients with 719 reporting no flares, and 409 in current flares at the time of the survey (Table 1). A minority reported perceived increases in disease activity which were associated with multiple aspects of perceived stress. At survey completion, 346 had not experienced flares, 290 had experienced one flare, and 492 had experienced multiple flares. Use of DMARDs was associated with lack of flare versus current flare (77.8% versus 71.6%, p = 0.02). The use of conventional synthetic, biologic, or targeted synthetic DMARDs were not associated with flare while current corticosteroid use was associated with flare (9.3% without flare and 20.8% with flare, p &lt; 0.0001). Current flare was associated with increased PSS-4 scores (odds ratio (OR): 1.17 (95% confidence interval: 1.12 – 1.22, p &lt; 0.0001). Figure 1 describes the odds ratio of experiencing aspects of stress with the presence of RA flare. Table 1. Current RA flare at time of survey completion Current Flare Current Flare Yes P-Value No N=409 N=719 RA duration (mean ± SD) years 15.6 ± 12.3 14.9 ± 11.6 0.3133 Patient Global (mean ± SD), range 0-10 3.5 ± 2.5 6.1 ± 2.2 &lt;0.0001 RAPID3 (mean ± SD) range 0-30 6.1 ± 5.6 13.7 ± 5.7 &lt;0.0001 Patient-Reported Remission, no. (% ) 404 (57.1%) 49 (12.1%) &lt;0.0001 RA-FQ Score, (mean ± SD), range 0-50 13.4 ± 11.4 29.7 ± 10.8 &lt;0.0001 PSS-4, (mean ± SD ) 5.2 ± 3.1 6.9 ± 3.1 &lt;0.0001 Overall stress level (% ) 0.0004 Increased 62.3% 72.9% Unchanged 26.9% 21.8% Decreased 10.7% 5.4% Current RA Therapy Any DMARD 77.8% 71.6% 0.0218 csDMARD Only 31.4% 26.7% 0.0911 bDMARD Only 18.1% 16.9% 0.6082 tsDMARDs Only 3.3% 3.4% 0.9394 bDMARD + csDMARD Only 19.8% 19.8% 0.9823 tsDMARD + csDMARD Only 4.6% 4.9% 0.8188 Current Corticosteroid 9.3% 20.8% &lt;0.0001 SD = standard deviation; No. = number; RA = rheumatoid arthritis; RAPID3 = routine assessment of patient index data 3; RA-FQ = rheumatoid arthritis flare questionnaire; PSS-4 = perceived stress scale; D/C = discontinued; DMARD = disease modifying antirheumatic drugs; csDMARD = conventional synthetic DMARD; bDMARD = biologic DMARD; tsDMARD = targeted synthetic DMARD Conclusion In a large survey population of RA patients during the COVID-19 pandemic, multiple aspects of stress were found to correlate with RA disease activity and flare. Disclosure of Interests Daniel Furst Consultant of: Corbus; Galapagos; Novartis; Amgen, Grant/research support from: Actelion; Galapagos; National Institutes of Health; GlaxoSmithKline; Sanofi; Corbus; Pfizer; Novartis; Amgen; Bristol Myers Squibb; Roche/Genentech, Nicolette T Morris: None declared, Angela Q Pham: None declared, Thasia Woodworth: None declared, David Elashoff: None declared, Jenny Brook: None declared, Veena Ranganath Grant/research support from: Bristol Myers Squibb; Mallinckrodt Pharmaceuticals